Provider Demographics
NPI:1275671778
Name:RICHARD R STOUT MD PLLC
Entity Type:Organization
Organization Name:RICHARD R STOUT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-789-3937
Mailing Address - Street 1:70 MASON ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1104
Mailing Address - Country:US
Mailing Address - Phone:315-789-3937
Mailing Address - Fax:315-789-2616
Practice Address - Street 1:70 MASON ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1104
Practice Address - Country:US
Practice Address - Phone:315-789-3937
Practice Address - Fax:315-789-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225735207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
141751CROtherPREFERRED ONE
7702618OtherDOCTORS HEALTH PLAN
P00141516OtherRAILROAD MEDICARE
141751CROtherPREFERRED CARE OPTION
82636OtherFIRST HEALTH
4086529OtherAETNA
NY02368770Medicaid
7700447OtherMVP SELECT CARE
P0100225735OtherHEALTHY NY
=========OtherUNITED HEALTH CARE EMPIRE
P0100225735OtherHEALTHY NY
=========OtherPOMCO
P00141516OtherRAILROAD MEDICARE
NY02368770Medicaid
7702618OtherDOCTORS HEALTH PLAN
4086529OtherAETNA
=========OtherUNITED HEALTH CARE EMPIRE
=========OtherGROUP HEALTH INCORPORATED